Behind The Scenes
Stories Behind the Stories
The original inspiration for the CASUALTY 1900s strand came from private diaries written by the grandfather of series producer Bryn Higgins. He (Thomas) trained to be a surgeon at the London just before the First World War (in fact, if the series runs again in 1910, Thomas may become part of the cast!). The diaries describe life at the London where Thomas was taught by some of the characters featured in CASUALTY 1909, including Henry Dean and Hurry Fenwick.
But the diary is just the tip of a huge research iceberg. The production sent in a team of researchers headed by Heather Forrester and Suzy Strong to the vast archives of the London hospital. These underground archives are possibly the largest and most fascinating in the world, stuffed with remarkable documents from a hospital that has dealt with London’s East End poverty and immigrants for over 200 years. The hugely knowledgeable curator, Jonathan Evans, is the historical consultant for the series.
After sifting through hundreds of case notes, ward diaries, autopsy records, committee reports as well as newspaper stories and private papers, the producers and script executive, Hilary Norrish, spent weeks boiling down the research into a set of workable stories. In order to make the archives work as a drama series the times and dates of events are fluid; we aimed for a rich blend of shocking, moving, informative and unusual – emphasising both how different things are today, and sometimes how similar. A set of possible story lines and characters were then provided for the script writers who picked over the bones and decided how they wanted to flesh them out.
Stories Behind the Stories
It’s an enjoyable and rewarding challenge to remain true to the times whilst also answering the needs of modern drama. Having the original research helps to keep the writing and performances ‘honest’, since it sometimes feels like the eyes of the original doctors, nurses and patients are peering over our shoulders. It brings an additional sense of responsibility and can add layers of detail that might otherwise be missed. Sometimes the scripts contain quite exact versions of original scenes, even using dialogue from old sources. At others, we invent a good deal of character and event – but always try to remain close to the practices or stories of the day.
The cast and crew all receive ‘info packs’ about the working practices at the London and the world outside at the time. Some request specific information about their character but this is not a game of replication - it is important that everyone feels they can bring their own insight and interpretation to the piece.
The intelligence, rigour and quality of the series all help to attract leading writers and cast – it is an immense pleasure to work with them, and for us all to end up with something that we are really proud of.
Fat Cures
Mrs Anderson is based on a woman who appears in the records many times, repeatedly coming back to the hospital with odd ailments. She suffered from obesity, alcoholism and loneliness.
The anti-corpulent preparation she is shown taking in episode one is based on real products available at the time. Many were available by post from adverts placed in the backs of magazines and newspapers. They often boasted impressive results, such as Russell's anti-corpulent preparation which claimed to remove a, "considerable quantity of the most unhealthy fat," in just twenty four hours. Chemical tests revealed that the preparation was only a mixture of citric acid and water with no direct fat reducing effects. Other remedies did lead to weight loss but were much more harmful to the body, such as laxatives, diuretics and even tapeworm eggs.
Child Prostitutes
Deborah’s uncle brings her into the London with broken ribs. In the examination room Dr. Culpin becomes suspicious of Deborah’s claims to be a seamstress and later Sister Ada Russell’s kindness allows Deborah to finally tell her the terrible truth.
Deborah is based on the huge number of child prostitutes at work in London at this time. In 1885 there was a huge scandal when W.T. Stead of the Pall Mall Gazette reported in detail the means by which he had bought a 13 year old girl for £5. He described how he had made the deal with her mother, who later went on to refute the claim and Stead was briefly imprisoned. However, the story highlighted what was a real problem in Edwardian society and soon after the age of consent was raised from 13 to 16.
Generally it was not at all uncommon for girls under 16, who were already in full time jobs, to enter into prostitution to ensure they had enough money to buy food and support their family. Work was especially easy to find because of a belief at the time that sex with virgins was a cure for venereal diseases. Child prostitution in London remains a problem today.
Anaesthetics
As Hurry Fenwick points out in episode one, “Anaesthesia is not a science. It’s an art.” His sentiment is echoed in the textbook Practical Anaesthetics (1923) which states, “It must be clearly recognised that no definite rules can be given as to the quantities of anaesthetics which should be administered.”
It was the job of the anaesthetist to decide the suitable dose for their patient, based on factors such as body size and the type of operation. There was also the Law of Diminishing Resistance to contend with, whereby, as an operation continued the patient requires less and less anaesthetic to keep them in narcosis: “Children exhibit this most markedly, and it will be found that towards the end of a tedious operation an infinitesimal dose will suffice.” It is understandable then, that the death of Michael in episode one from anaesthesia was not at all uncommon in 1909. Hospitals had no dedicated anaesthetists, there were only doctors who would take on the role. When experienced doctors were not available it would fall upon junior doctors to take over, who had sometimes only minimal experience.
Anaesthesia in the modern era is far safer than it was in 1909. For one we now have trained anaesthetists who undergo as many years of medical study as doctors and surgeons. In 1909 once an operation was underway the only means by which to monitor the patient were to feel for their pulse, listen to their breathing and note their colour: deaths could easily be caused by the anaesthetist becoming distracted. These days technology provides not only accurate but constant monitoring of patients. The beeping of the Electrocardiogram we so readily associate with surgery gives a constant indication of the patient’s heart rate. The level of oxygen in the blood is also measured, as is the ratio of gas to air in the anaesthetic. With all these improvements it is not surprising that there are now only around five deaths for every million anaesthetics given.
Polio
In episode 3 Issy Modinski is brought to the London unable to eat or use his legs. Dr. Head ascertains that he is suffering from Poliomyelitis, a disease virtually unknown in England at the time.
Polio has been around for centuries but case records of Polio victims only go back to 1912. One reason for this is that the majority of Polio infections cause only fever, headache and muscle ache, all of which can be mistaken for other conditions. In rare cases the Polio virus enters the central nervous system where it causes inflammation. It is from this symptom that Polio gets its full name: Poliomyelitis - inflammation of the spinal cord.
Although the condition of paralysis often subsides over time it can leave permanent muscle damage and deformities. However, other conditions such as fatigue and breathing difficulties may appear years later in what is called Post Polio Syndrome.
Polio outbreaks in Europe and America made Polio one of the most feared diseases in the early 1900s. An effective vaccine was developed in the 1950s which has nearly eradicated the disease from most developed countries. However, there are many survivors still living with the effects of Polio today.
Receiving Room
In 1909 the Receiving Room reported over 140,000 cases. Amongst them are cases that we follow in the series, and others that we just catch a glimpse of.
The two drunken women we see fighting with gin bottles in episode 2 come from The Elephant Man, by Frederick Treves. He records that, “They were large, copious women who were both in an advanced stage of intoxication. They had been fighting with gin bottles…the round, smooth bottoms of the bottles are knocked off and the combatants proceed to jab one another in the face.”
One of the most unique cases is seen in episode 5 when a man mauled by a lion is brought into the hospital. The case notes report that he had a, “deep wound to the lower side and on the back of the right hand,” but made a good recovery.
Goldberg, brought in by his father in episode 2, is described in the case notes as suffering from, “acute mania,” including paranoia and excited talking. He was a 26 year old cook who may have been suffering from what we now know of as Schizophrenia.
The most familiar face among the patients in the Receiving Room is that of Mrs Anderson. She appears throughout the series and likewise in the London’s case notes they record, “she seemed to cling to the hospital and came to report herself often, even when the worse for a drink.” Her first entry reports that she had injured her finger while intoxicated but it emerges that she had been through difficult circumstances and seemed, “hopeless about herself.” The hospital provided food and clothing but she relapsed into alcoholism several times. Eventually she, “became herself again, getting fairly regular work at a tailors and paying her own way.” Her story ends happily in the records when she sets out to be reunited with her husband, who lived a great distance away but had been calling for her. The hospital provided money for the fare, a trunk, umbrella and clothes.